小剂量抗CD3单克隆抗体治疗肾移植术后早期急性排斥反应的临床研究

目的探讨应用小剂量抗CD3单克隆抗体(OKT3)治疗肾移植术后早期急性排斥反应的效果和安全性.方法将33例发生早期急性排斥反应的肾移植病人分为两组,A组16例(OKT3 5 mg/d);B组17例(OKT3 2.5mg/d).观察排斥反应逆转情况及感染的发生率.结果A组13例(81.25%)急性排斥反应逆转,移植肾功能恢复正常;1例移植肾自发性破裂行移植肾摘除术,2例移植肾失功恢复血液透析.B组15例(88.24%)急性排斥反应逆转,移植肾功能恢复正常;1例移植肾自发性破裂行移植肾摘除术,1例移植肾失功恢复血液透析.两组排斥反应逆转率无显著性差异(P＞0.05).A组合并感染43.75%,B组5.88%;两组比较有显著性差异(P＜0.05).结论小剂量OKT3治疗肾移植术后早期急性排斥反应的效果良好,并发症少,且费用较低.     

大肠癌流行因素的研究现状

大肠癌的发生是多冈素，多步骤的过程。其发生与饮食类型、遗传因素、结直肠良性病变、生活习惯、心理因素、药物等凶素密切相关。全文就大肠癌流行因素的研究现状作一综述.     

Palliative treatment of malignant ascites by intraperitoneal bleomycin after dialytic ultrafiltration with haemofilter

Dialytic ultrafiltration with haemofilter was performed in 16 patients with malignant ascites refractory to treatment with sodium restriction, diuretic and systemic chemotherapy. A continuous flow of ascitic fluid at a rate of 300–400 ml/min through a haemofilter was maintained by a blood pump. The protein-rich ascitic fluid was re-infused into the peritoneal cavity with sodium and water removed. An average of 5.2 1 of filtrate was removed over a mean interval of 3.5 h. Bleomycin (60 mg) was administered intraperitoneally following the procedure. Complete response was observed in six patients (37.25%) and partial response occurred in four (25%). The remaining patients showed no response. Complications of the dialytic ultrafiltration procedure and toxicity of intraperitoneal administration of bleomycin were minimal. The technique of dialytic ultrafiltration is simple, safe and cost-effective and could be used as an adjuvant therapy for intraperitoneal chemotherapy.     

CELL-DYN1700血球计数仪常见故障及解决方法

本文分析了CELL-DYN1700血球计数仪测量结果、主机硬件、数据处理及结果显示等几大部分的常见故障，并阐述了解决此类问题的方法。     

影响梗阻性肾病预后的相关因素

目的:探讨梗阻性肾病预后的相关因素.方法:对339例梗阻性肾病患者的临床资料进行回顾性分析,对各变量做统计分析,对各因素进行Logistic分析.结果:41例患者死亡.影响梗阻性肾病预后的危险因素分析中9个因素经过单因素和多因素Logistic回归,最后酸中毒(OR=2.484,P＜0.001)、低蛋白血症(OR=1.136,P=0.019)、全身炎症反应综合征(SIRS)(OR=3.505,P＜0.001)、复杂性尿路梗阻(OR=1.529,P＜0.001)、年龄(OR=1.664,P＜0.001)、并存疾病(OR=6.103,P＜0.001)、肾衰竭(OR=1.918,P＜0.001)、肾皮质变薄(OR=0.256,P=0.001)8个因素进入回归方程.结论:SIRS、酸中毒、复杂性尿路梗阻、低蛋白血症、并存疾病(冠心病等)、肾衰竭、高龄是影响梗阻性肾病患者预后的危险因素.     

High incidence of and risk factors for metachronous bilateral upper tract urothelial carcinoma in Taiwan

AIM: Urothelial carcinoma (UC) can occur multifocally in the whole urothelium. A higher rate of bilateral metachronous upper tract (UT) UC was noted in Taiwan. The incidence and risk factors were largely unknown and hence were explored in the study. METHODS: From January 1977 through June 2003, 462 patients with unilateral UT-UC were studied retrospectively. The cumulative incidence of contralateral recurrence was analysed with the Kaplan-Meier analysis. Potential risk factors for contralateral recurrence including age, smoking, bladder cancer, renal function, diagnostic year etc. were evaluated with the log-rank test. Independent risk factors were identified by using the Cox regression analysis. RESULTS: The median follow-up time was 34 months (6-337). Among the 462 patients, 52 (11.3%) developed metachronous contralateral UC. The 2, 5, and 10-year contralateral disease-free survivals were 93.5%, 84.0%, and 75.7%, respectively. The median time to contralateral recurrence was 31.0 months. With the univariate analysis, only poor renal function (serum creatinine < or > OR =2.0 mg/dL, P < 0.001) and late diagnostic year (before or after 1990, P < 0.001) were risk factors for contralateral recurrence. In the multivariate analysis, poor renal function (hazard ratio: 2.98; 95% confidence interval: 1.67-5.33; P < 0.001) and late diagnostic year (hazard ratio: 4.27; 95% confidence interval: 1.71-10.65; P = 0.002) remained independent risk factors. CONCLUSIONS: The incidence of metachronous UT-UC is high in Taiwan. Patients who had either chronic renal insufficiency or a disease diagnosed after 1990 had a higher risk of contralateral recurrence.     

复发性胶质瘤再手术治疗的探讨

目的 探讨复发性胶质瘤患者再手术的效果。方法 对22例复发性胶质瘤患者再手术前的功能状态、两次手术间隔时间及手术切除的程度与术后存活期等资料进行临床和统计学分析。结果 第二次手术前生活能自理或半自理的病人（Kamofsky计分≥60）平均生存期约16月，生活不能自理的病人（Kamofsky计分〈60）平均生存期约6月（P〈0．01）。两次手术间隔时间大于1年者平均生存期约17月，间隔时间小于半年者平均生存期约6月（P〈0．01）。手术肿瘤全切除者平均生存期约15月，次全切除者平均生存期约10月（P〈0．05）。结论 术前功能情况好，手术间隔时间大于1年及术中全切肿瘤者再手术治疗可获得较好效果。     

痧斯病(SARS)

严重急性呼吸道综合征(severe acute respiratory syndrome，SARS)是由SARS相关冠状病毒(SCV)引起的一种新的烈性呼吸遗传染病。急性期重症病例肺部病变为严重的急性间质性渗出性炎，类似呼吸窘迫综合征的病理特征。肺外器官主要为出血坏死性炎。临床诊断是一个动态的过程，随着对SARS认识的加深，诊断标准将会不新完善。文中对命名进行了讨论，中文名建议用痧斯病。     

Effects of Pharmacological Autonomic Blockade on Dual Atrioventricular Nodal Pathways Physiology in Patients with Slow-Fast Atrioventricular Nodal Reentrant Tachycardia

The purpose of this study was to investigate the atrioventricular AV nodal physiology and the inducibility of AV nodal reentrant tachycardia (AVNRT) under pharmacological autonomic blockade (AB). Seventeen consecutive patients (6 men and 11 women, mean age 39 ± 17 years) with clinical recurrent slow-fast AVNRT received electrophysiological study before and after pharmacological AB with atropine (0.04 mg/kg) and propranolol (0.2 mg/kg). In baseline, all 17 patients could be induced with AVNRT, 5 were isoproterenol-dependent. After pharmacological AB, 12 (71 %) of 17 patients still demonstrated AV nodal duality. AVNRT became noninducible in 7 of 12 nonisoproterenol dependent patients and remained noninducible in all 5 isoproterenol dependent patients. The sinus cycle length (801 ± 105 ms vs 630 ± 80 ms, P < 0.005) and AV blocking cycle length (365 ± 64 ms vs 338 ± 61 ms, P < 0.005) became shorter after AB. The antegrade effective refractory period and functional refractory period of the fast pathway (369 ± 67 ms vs 305 ± 73 ms, P < 0.005; 408 ± 56 ms vs 350 ± 62 ms, P < 0.005) and the slow pathway (271 ± 30 ms vs 258 ± 27 ms, P < 0.01; 344 ± 60 ms vs 295 ± 50 ms, P < 0.005) likewise became significantly shortened. However, the ventriculoatrial blocking cycle length (349 ± 94 ms vs 326 ± 89 ms, NS) and effective refractory period of retrograde fast pathway (228 ± 38 ms vs 240 ± 80 ms, NS) remained unchanged after autonomic blockade. Pharmacological AB unveiling the intrinsic AV nodal physiology could result in the masking of AV nodal duality and the decreased inducibility of clinical AVNRT.     

胰岛素样生长因子结合蛋白与胰岛素抵抗的关系

胰岛素样生长因子系统是一个由配体、受体、结合蛋白及蛋白酶构成的复杂网络,会受到诸多因子的调节.该系统中的胰岛素样生长因子结合蛋白在不同细胞的增殖和分化中起着重要的作用.临床及体内外研究表明胰岛素抵抗形成过程中,IGFBP出现异常表达.IGFBP通过不同机制抑制或促进胰岛素抵抗的形成.